Hajnalka HegedHajnalka Heged s, MDs, MD
covered by the Glisson's capsule; intraperitonealorgan (except the bare area [area nuda hepatis] )diaphragmatic surfacevisceral surfaceright lobe(located in the right hypochondrium)
left lobe(in the epigastrium and left hypochondrium)
falciform ligament
inferior border of livernotch for round ligament of liver
derivativederivative ofof thethe embryonicembryonic ventralventral mesogastriummesogastrium
falciform ligamentLig. teres hepatisLig. teres hepatisLig. teres hepatisround ligament
right lobe left lobe
VisceralVisceral surfacesurface (1) (1) HH-- shapedshaped setset ofofgroovesgrooves
left-hand limb of the H :- in the anterior halffissure for round lig.: round lig. (remnant of theumbilical vein)- in the posterior halffissure for lig. venosum: lig. venosum (remnant ofthe ductus venosus)
right-hand limb of the H :- in the anterior half
fossa for gallbladder:gallbladder
- in the posterior halfgroove for vena cava:
_inferior vena cava
cross-bar of the H is the porta hepatis: - common hepatic duct (on the right)- hepatic portal vein- hepatic artery proper (on the left)
Anterior to the porta hepatis, there is a lobe(between the fissure forround lig. and the fossa for gallbladder):
*QUADRATE LOBE
Posterior to the porta hepatis, there is anotherlobe (between the fissurefor lig. venosum and thegroove for venae cava):
*CAUDATE LOBE(papillary and caudate
processes)
remnant of ductus venosus
connective tissue bundle
inferior vena cava
porta hepatis
gallbladder
PeritonealPeritoneal attachmentsattachments ofof liverliver(( intraperitonealintraperitoneal expectexpect forfor thethe BARE AREA)BARE AREA)
falciform lig. of liver(remnant of the ventralmesogastrium)a/ left coronary lig. lefttriangular lig. fibrousappendixb/ right coronary lig.hepatorenal lig. righttriangular lig.BARE AREA of LIVER
LESSER OMENTUM- hepatogastric lig.- hepatoduodenal lig.
- bile duct (choledochal duct) /on the right/- hepatic portal v. /behind theother two items/- a. hepatica propria /on theleft/ChoVA!
BloodBlood supplysupply totothethe liverliver, , andand itsitsvenousvenous drainagedrainage
LymphaticLymphatic drainagedrainageandand innervationinnervation ofof thetheliverliver
hepatic a. proper (from commonhepatic a. ; from coeliac trunk)
hepatic portal v.
interlobar a. and v.
interlobular a. and v.
perilobular a. and v.
hepatic sinuses (mixture)
central v.
sublobular v.
hepatic veins inferior vena cava
- lymphatics originate in the interlobularconnective tissue, the larger lymphatic vesselsleave the liver in some pathways:
- via the porta hepatis hepaticlymphatic nodes
- along the hepatic vv. media-stinal lymphatic nodes
- in the falciform lig. para-sternal lymphatic nodesi and nodesaround the aorta
Innervation: coeliac ganglionvagus n. (cranial n. X)
Parts: fundusbodyneckcystic duct
common hepaticduct
bile duct
Peritoneal attachmentsBlood supply and venousdrainagecystic a. hepatic a. propercystic v. hepatic portal v.Lymphatic drainage: lymphnodes of porta hepatis
gallbladdergallbladder / / bilebile cystcyst / / cholecystacholecysta
PracticalPractical assignmentsassignments (( liverliver))
Study the peritoneal attachments of the liver,surfaces,items of the H-shaped set of grooves and theircontents.
Inferior margin of the liver is lifted, and the following items should be found:
- hepatoduodenal lig. containing(1) bile duct / choledochal duct on the right(2) hepatic portal v. between and behind the other two structures(3) hepatic a. proper on the left) ChoVA!
- porta hepatis
11--22Parts of pancreas Excretory ducts of the
pancreas
head of pancreasuncinate process of pancreas
pancreatic notch
body of pancreasomental eminence(bulges into the omental bursa)
tail of pancreas
at its superior margin splenicvessels (a. and v.)
-- pancreatic duct (Wirsung duct)(in the tail and body)opens into the hepatopancreatic ampullamajor duodenal papilla (papilla of
Vater)
- accessory pancreatic duct (Santoriniduct)(in the head)minor duodenal papilla (papilla ofSantorini)
Topographical relationships ofthe duodenum and the pancreas
PancreasPancreas: : bloodblood supplysupply, , venousvenous andandlymphaticlymphatic drainagedrainage andand innervationinnervation
superior pancreaticoduodenal a.inferior pancreaticoduodenal a.splenic a. (supplies the body and tail)
splenic v. to the hepatic portal v.
Lymphatic drainage:preaortin lymph nodes
Innervation:coeliac ganglionvagus nerve
(supply the head)
PracticalPractical assignmentsassignments (( pancreaspancreas))
Study the topographical anatomy of the pancreas
Find the superior mesenteric vessels (a. and v.)
Explore the vicinity of the superior margin of the
pancreas; examine the splenic a., and the
accompanying splenic v.)
Follow the splenic v. to the hepatic portal v.
Isolate the coeliac trunk above the superior margin aof
the pancreas